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ACEP Now: Vol 34 – No 04 – April 2015(click for larger image) Table 1: EDBA Data Survey 2013, Single-Year Cohort
Utilization of CT scans appears to have peaked and has decreased during the last two years, based on the EDBA data surveys over the last 10 years (see Table 2). CT utilization peaked at 22 CT scans per 100 patients seen between 2006 and 2011. There was a 10 percent drop in utilization to 20 CT procedures per 100 patients seen in 2012 and 2013. This is consistent with a recent report that showed decreased growth in CT and MRI imaging rates over the last nine years.1
(click for larger image) Table 2: EDBA Data Survey 2013, Trend Data
There is about a 50 percent difference in CT utilization based on ED volume, with the range between 16 and 24 procedures per 100 patients seen. Pediatric EDs only use CT imaging about four times per 100 patients seen. Plain diagnostic X-rays show little difference in utilization based on volume.
According to the EDBA report, MRI utilization across all EDs has now reached about 1.3 procedures per 100 patients seen, but this increases to 1.9 in the high-level trauma centers.
Trauma centers utilize diagnostic imaging to evaluate patients with critical injuries. Within the EDBA data set, the data have been sorted into separate cohorts of trauma centers (see Table 3). Pediatric trauma centers have very different profiles than general EDs, so they are excluded. The three cohorts are Level I and II trauma centers, Level III and IV trauma centers, and all other EDs.
(click for larger image) Table 3: EDBA Data Survey 2013, Comparison of Trauma and Nontrauma Centers
Table 3 shows that the higher-level centers see patient populations with higher acuity, admission rates, emergency medical services (EMS) arrival, and longer time for processing. There are also differences in the use of diagnostics commensurate with the trauma level.
CT scans are used more frequently in Level I and II trauma centers than in lower-level centers. There are 26 CT procedures per 100 patients seen in Level I and II trauma centers and 18 to 20 procedures in lower-level and nontrauma centers. Emergency physicians in these EDs should be aware of the differences, and when called upon to study their utilization, they should compare their experience to cohorts at a similar level of trauma designation and pediatric mix.
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2 Responses to “Diagnostic Testing Usage Data Can Help Emergency Physicians Manage Utilization”
June 12, 2015
henry richterDrs. Augustine and Broida:
REF: “The ED diagnostic Center”, ACEP NOW April 2015
Your article brings up an interesting though subtle issue. Particularly focusing on soft tissues imaging ( US, CT, MRI), many of these tests are normal. The quick response is to bemoan the these normals as ” over-utilization”. However, the normals are of immense utility if used in the following manner.
Please be aware I am not an academic and these observations are based on a 36 yr medical career, half spent in ED care, and half in primary care.
Every normal test is predictive of remaining normal for a period of time. This infers that repeating the test will be de-facto over-utilization. The issue then is how long is this period of time? How much can this time interval be generalized to a population? How much of this time interval is specific to a single patient?
Let me give examples. A normal biliary ultrasound will remain normal, in the sense of the diseases of ED interest, for years. Two years at least, approaching five years in a younger cohort. A normal CT pulmonary angiogram essentially rules out any consideration of PE close to forever. Any PE that occurs in the years after a normal test must then immediately provoke a search for an underlying cause. A normal CT abd/pelvis is good for at least a year.
Of course clinical acumen is available, at any time, to over rule these generalizations. Cancer changes everything.
The statistics in your article do not educate me any any useful way. So what is my basic thought. However, I am presenting you with an opportunity to delve into barren numbers and attempt to find a teachable moment for providers. Will you design a study to track the stability of patients given certain imaging results? As our profession moves into the era of ACOs, the issues increases in importance.
Henry Richter MD
July 20, 2015
When the Hospital CEO Questions Test Utilization in the ED - THE FICKLE FINGER[…] has done a nice overview of the issue of the use of diagnostic testing utilization data in the ED, and this covers the issue in more […]